Participants from many pediatric and acute care specialties attended. They left with greater scanning skills, reduced reliance on CT scans, a multi-tool, and one lucky winner received Kaushal Shah’s new junior medical detective book, My Tummy Hurts

Our next hands-on ultrasound course will be in Ponte Vedra, Florida on June 17 at the Clinical Decision Making conference.

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The Mount Sinai Department of Emergency Medicine hosted its annual ultrasound CME conference on April 25. Faculty, fellows, nurses and PAs from a number of institutions and specialties took part in our tenth annual course.

Subpleural consolidation:

Confluent B-Lines:

Multiple B-Lines:

And now for something completely different

Z-Lines: Comet tails that arise from the pleural line but DO NOT make it to the bottom of the ultrasound screen. These are not B-lines. These artifacts have not been associated with any pathology, and they do not obliterate A-lines.

For more details on the sonographic appearance of viral lung pathology, check out this article by Jim Tsung.

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Thoracic sonography is one of the most rapidly growing areas of emergency and critical care ultrasound. One very important emerging indication is to assess for lung consolidation. The characteristic appearance of consolidated lung is very sensitive and specific for pneumonia, but novices should heed some important pitfalls in making the diagnosis.

Special thanks to Jim Tsung, MD, MPH and Brittany Jones, MD for their tips, videos, and ongoing research in this important field! For further reading on this topic, please see this article.

Pitfall #1 – confusing thymus for a consolidation

Normal thymus in sagittal view:

Thymus (top half of screen) and heart (bottom right). Don’t confuse thymus for lung consolidation. Note there are no air bronchograms, but thymus has a faint speckled appearance.

Normal thymus in transverse view:

Thymus (top half of screen) and heart (bottom right). Don’t confuse thymus for lung consolidation. Note there are no air bronchograms, but thymus has a faint speckled appearance

Pneumonia adjacent to Thymus in transverse view:

Lung consolidation with air bronchograms (top left) adjacent to normal thymus (speckled appearance on top right) with heart (bottom right)

Pitfall #2 – mistaking spleen for consolidation.

This is an important pitfall for everyone to know about. The same issue applies to the liver & stomach. The sensitivity of lung US for pneumonia rises >90% if this mistake is avoided.

Left lower chest- sagittal view:

Be careful scanning the left lower chest (left anterior and left axillary line) – air in stomach and spleen may look like pneumonia if you don’t realize that you have scanned inferior to the diaphragm and past the end of the pleural line. Most common error by novices.

Left lower chest- transverse view:

Be careful scanning the left lower chest (left anterior and left axillary line) – air in stomach and spleen may look like pneumonia if you don’t realize that you have scanned inferior to the diaphragm and past the end of the pleural line.

Congratulations to Sinai’s own Dr. Jim Tsung, who recently coauthored a major evidence-based consensus guideline on point-of-care lung ultrasound. The manuscript is the result of a multi-national effort by pioneering clinician-sonographers, and was just published in the journal Intensive Care Medicine:

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Sinai’s own Dr. Lana Friedman, Pediatric Emergency Medicine Fellow, was just named one of three recipients of the prestigious SPR Fellow Clinical Research Award. Her abstract entitled, “Accuracy of Point-of-Care Ultrasound (PoCUS) by Novice Pediatric Emergency Sonologists in the Diagnosis of Skull Fractures,” was selected from a very competitive pool of submissions. She will present the abstract at the PAS meeting in Denver in April.
Congratulations to Dr. Friedman and her research advisor, Dr. Jim Tsung!